ArticleThe western journal of emergency medicine2019
Challenges Related to the Implementation of an EMS-Administered, Large Vessel Occlusion Stroke Score.
Article in The western journal of emergency medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Stroke Scales for Large Vessel Occlusion in the Prehospital Emergency Setting: A Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2026Pooled it
- Variation in Prehospital Routing Patterns for Patients With Suspected Stroke.Journal of the American Heart Association · 2025Article
- Sensitivity of a Qualitative 5-Element Cortical Sign Screen for Detecting Acute Basilar Artery Occlusion.Journal of the American College of Emergency Physicians open · 2025Article
- Cincinnati Prehospital Stroke Scale (CPSS) as a Screening Tool for Early Identification of Cerebral Large Vessel Occlusions; a Systematic Review and Meta-analysis.Archives of academic emergency medicine · 2024Review
- [Comparison of RACE scale to other assessment scales for large vessel arterial occlusions in the out-of-hospital level: a rapid review].Anales del sistema sanitario de Navarra · 2021Review
- Emergency medical dispatchers' ability to identify large vessel occlusion stroke during emergency calls.Scandinavian journal of trauma, resuscitation and emergency medicine · 2021Article
- Emerging Detection Techniques for Large Vessel Occlusion Stroke: A Scoping Review.Frontiers in neurology · 2021Article
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Authors and funding
9 authors.
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No grant is acknowledged in the PubMed record.
Abstract
introductionThere is considerable interest in triaging victims of large vessel occlusion (LVO) strokes to comprehensive stroke centers. Timely access to interventional therapy has been linked to improved stroke outcomes. Accurate triage depends upon the use of a validated screening tool in addition to several emergency medical system (EMS)-specific factors. This study examines the integration of a modified Rapid Arterial oCcclusion Evaluation (mRACE) score into an existing stroke treatment protocol.
methodsWe performed a retrospective review of EMS and hospital charts of patients transported to a single comprehensive stroke center. Adult patients with an EMS provider impression of "stroke/TIA," "CVA," or "neurological problem" were included for analysis. EMS protocols mandated the use of the Cincinnati Prehospital Stroke Score (CPSS). The novel protocol authorized the use of the mRACE score to identify candidates for triage directly to the comprehensive stroke center. We calculated specificity and sensitivity for various stroke screens (CPSS and a mRACE exam) for the detection of LVO stroke. The score's metrics were evaluated as a surrogate marker for a successful EMS triage protocol.
resultsWe included 312 prehospital charts in the final analysis. The CPSS score exhibited reliable sensitivity at 85%. Specificity of CPSS for an LVO was calculated at 73%. For an mRACE score of five or greater, the sensitivity was 25%. Specificity for mRACE was calculated at 75%. The positive predictive value of the mRACE score for an LVO was estimated at 12.50%.
conclusionIn this retrospective study of patients triaged to a single comprehensive stroke center, the addition of an LVO-specific screening tool failed to improve accuracy. Reliable triage of LVO strokes in the prehospital setting is a challenging task. In addition to statistical performance of a particular stroke score, a successful EMS protocol should consider system-based factors such as provider education and training. Study limitations can inform future iterations of LVO triage protocols.
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